Margaret Gulledge OTR OTD Barbara Nadeau PhD OTRL Occupational Therapy Department Occupational Therapy Doctorate Program Objectives Participants will understand the benefit of using an occupation based frame of reference such as PEOP for health promotion study and intervention developme ID: 685552
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successful long term lifestyle change: A peop perspective
Margaret Gulledge, OTR, OTDBarbara Nadeau, Ph.D., OTR/LOccupational Therapy DepartmentOccupational Therapy Doctorate ProgramSlide2
Objectives
Participants will understand the benefit of using an occupation based frame of reference such as PEOP for health promotion study and intervention development.Participants will understand the potential internal and external influences on successful long term lifestyle change to improve health.Participants will learn potential application and interventions to be used in daily OT practice.Participants will understand future opportunities to address the emerging niche of Health Promotion.Slide3
QuizSlide4
Background/Intro84% of healthcare dollars spent on chronic disease (CDC, 2014)
50% of adults have at least one chronic disease; ¼ of those individuals have one more ADL limitationsInterventions directed at improving lifestyle choices could result in improved health and quality of life and reduce costs. (CDC, 2014)Four common causes of chronic diseases: limited physical activity, poor nutrition, smoking and other tobacco, excessive alcohol use.Affordable Care Act of 2010 coverage for preventionSlide5
Texas
Heart disease is the leading cause of death in Texas. Also in the top 10 are chronic lower respiratory disease, CVA and diabetes.In 2014, 11.0% of adults diagnosed with diabetesIn 2014, 31.9% of the adult population in Texas was obese (BMI > 30)All-payer per-capita 2014 personal health care spending: 6998.00; national average 8045.00
Huntsville Memorial Hospital 2017 Community Health Needs Assessment identified the following priority:Prevention, Education and Services to address high mortality rates, chronic diseases, preventable conditions and unhealthy lifestyles.Slide6
Significance to Occupational Therapy
Health promotion emerging niche for OT (AOTA, 2013)OT has long history of promoting prevention but not typically recognized in that role (Hildebrand and Lamb, 2013)The need to address prevention has been described in literature since at least 1967 (West, 1967)OTPF identifies multiple practice domains to address prevention (AOTA, 2014)
AJOT – July/August 2017 issue: Special Issue on Occupational Therapy and Health, Well-Being, and Quality of LifeJuly 2017 issue of OT Practice – 2 articles addressing chronic disease and health behavior changeSlide7
Research Question
Purpose of the study: identify the person factors, environmental influences, performance patterns (habits, roles, and routines), and occupations among adults who have made a successful lifestyle changeThe Person-Environment-Occupation-Performance frame of reference was use to answer the following questionResearch question: How would individuals who have made a successful lifestyle change describe the influences on their long term success?Slide8
Theory: PEOP
Client centered, top down frame of reference (FOR) used for forming intervention plans Premise: People are motivated to explore and master the worldPeople who experience success are motivated to face bigger challenges.Dysfunction defined as “when people cannot perform their roles to a level of personal or social satisfaction”
Change occurs at level of occupational performance or level of participation
(Baum & Christiansen, 2005)
Slide9
Theory: PEOP
Person – intrinsic influences to include neurobehavioral, physiological, cognitive, psychological and emotional, and spiritual factorsEnvironment – Includes built environment, natural environment, cultural environment, societal factors, social interaction, and social and economic systemsO
ccupation - what people want or need to do in their lives.Performance – actual doing of the chosen occupations.Slide10
Supporting Literature
PEOP used to structure literature reviewUse of PEOP for health promotion supported Most studies address motivation or behaviorSome studies did address environment, social supportSupport identified for each component of PEOPNo studies identified included all componentsPEOP provides complete picture of all componentsSlide11
Methodology
Phenomenological approachPurposive sampling used to identify sample of six adultsData collected via semi-structured interviewsParticipants reviewed transcriptsTranscripts converted to table format using Microsoft Excel and WordTranscripts coded using descriptive and pattern codingData sorted and categorized using PEOP Common themes and subthemes emergedSlide12
Results
Participants and their stories:Todd – 56 y/old physician, father of 2 who lost 110 pounds after a serious health care scareSamantha – 49 y/old mother of 3 lost 100+ pounds; works in a weight loss clinicGreg – 31 y/old who embraced fitness lifestyle after years of drug addiction, owns a personal training studio with his wife.Slide13
Results
Chris – 28 y/old male who lost 100+ pounds, embraced a fitness lifestyle and pursued career in law enforcementJennifer – 41 y/old nurse and mother of 3 who lost 100+ via weight loss surgery and is now an avid runnerAnn – 36 y/old probation officer and mother of 2 who made a gradual lifestyle changes resulting in fitness lifestyle.Slide14
Results -
PersonSlide15
Results - P
ersonPhysiological FactorsPhysical health is required to perform many occupations (Baum & Christiansen (2005)Participants reported:
Improved health Decreased A1C, decreased blood pressure, decreased liver enzymes
Improved fitness
Addiction to exercise, stairs, doing surgery without breaking a sweat, running a marathon
“Exercise is Addictive” ; “Best addiction to have”
Increased ability and desire to do things
Willing to try anything such as knee boarding or walking the golf course, walking up and down bleachers at football game, improved work ethicSlide16
Results - P
ersonPsychological and emotional factors include personality traits, motivational influences and internal process that contribute to how a person behaves and performs (Baum & Christiansen, 2005).Participants reported:
MotivationLife event or health crisis
Motivated by success to continue; progress easy to see and addictive
Discipline
Hard, required mental toughness, priorities changed, new coping skills to manage stress and emotions, goals
“I don’t know if I could do it again, it was that hard”
Fear of backsliding
Afraid to let guard down, too much to loose, embarrassment with failureSlide17
Results - E
nvironmentSlide18
Results - E
nvironmentSocial InteractionPeople are social beings who may require social and emotional support networks for optimal occupational performance (Baum & Christiansen, 2005)Participants reported:
Emotional supportEncouragement, pride displayed by family with success, like minded friends
Task assistance
Childcare, helping with kitchen clean up to discourage snackingSlide19
Results - E
nvironmentSocietal Factors Human beings are social animals who place value on interpersonal relationships and their standing within a group (Baum & Christiansen, 2005)Participants reported:
Treated better in societyMore respect at work – treated better by supervisor, thought of as better doctorSlide20
Results - E
nvironmentBuilt EnvironmentThe physical properties of the environment and tools must be accessible and manageable for optimal occupational performance (Baum & Christiansen, 2005). Participants reported:
Easy access to workout equipment Hospital gym, gym near work
Improved comfort in the built environment
Airplane seats, amusement park ridesSlide21
Results - E
nvironmentEconomic FactorsEconomic factors frequently dictate whether an individual can access the community or services they require. When occupational performance is limited, economic factors may be affected as well. (Baum & Christiansen, 2005).
Participants reported:Fear of loss of incomeMajor surgery would result in time of work, need to look healthy for business
Cost of weight loss surgery
Investment spurred successSlide22
Results - OccupationSlide23
Results - O
ccupationSocial ParticipationParticipants reported:More confidence and self-esteem in social settingsVolunteering, chaperoning kid functions, not so shy
More willing to try new things Enjoying meeting new and different peopleSlide24
Results - O
ccupationLeisureParticipants reported:Experimenting with new leisure activities such as cycling or knee boardingUsing leisure activities to facilitate success
Fishing to supply healthy diet
Making jewelry as coping skill for stressSlide25
Results - O
ccupationSleepParticipants reported:Improved sleep as a result of weight lossLess fatigued during work day due to better sleep at nightSlide26
Results - P
erformanceSlide27
Results - P
erformanceHabitA single established and repeated behavior (Luebben & Royeen
, 2007)Participants reported:Replacing unhealthy habits with healthy habits
Counting calories
Eating more vegetables
Eliminating or reducing alcohol intake
Eliminating fast food
New exercise habitsSlide28
Results - P
erformanceRoutinesGroup of behaviors or habits put together in a certain, consistent and repetitive order. Participants reported:
Establishing new routinesRoutines rigid in beginning but flexible after period of timeRoutines remained rigid for at least 6 months, up to 3 years
Anxiety when diverted from their routines
Advanced planning used to remain on routines (food prep, holidays, etc.)
Separate routines for breaks in routines such as travel and vacationsSlide29
Results - P
erformanceRoles“Position in society having expected responsibilities and privileges” (Baum & Christiansen, 2005, p. 252)Participants reported:
New profession as result of lifestyle changePersonal trainer, police officer, weight loss counselor
Using roles in a positive manner to influence others after their lifestyle change
Physician, school nurse, familySlide30
Limitations
LimitationsCan inform knowledge, not be generalizedSingle researcher, single interviewSubjects acquainted with researcher, may not have been candidSlide31
Discussion
Results concurred with Lit review which suggests PEOP appropriate for lifestyle changePEOP yielded more complex picture than existing studies which tended to focus on just one or two areas such as motivation or behaviorThe combination of intrinsic and extrinsic influences were importantPerformance and Person most prominentLong term focus on rigidity of routines key to success
Environment and Occupation facilitators to Performance and
P
erson
Lifestyle change hard, long term commitment; reward worth sacrifice
Participants accepted responsibility for change
Advice to others “Make a commitment and start today”
“It’s a good life”Slide32
Discussion
OT long history of prevention discussion Study indicates OT ideal profession for lifestyle changeShould research other lifestyle change: smoking cessation, etc.Rich body of evidence needs to be developed Develop interventions for OT to address lifestyle changeInterventions must be cost effective
Develop funding options, 3rd party payersSlide33
Diabetes Prevention
Medicare Diabetes Prevention Program: structured intervention program with goal of preventing type II diabetesEvidence based model16 intensive weekly sessions of approved curriculum in a group-based setting followed by 6 months of less intense monthly sessionsPractical training in long-term dietary change resulting in 5% average weight loss
Billing privileges to begin January 2018“Pure” prevention; individuals diagnosed with diabetes will not qualify for this program
https://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2017-Fact-Sheet-items/2017-07-13-3.htmlSlide34
Cardiac Rehab
Multi-disciplinary outpatient rehab service to individuals diagnosed with CHF, MI, CABG, angioplasty with stent, stable angina, valve replacement, heart transplantProgram includes telemetry monitored exercise combined with lifestyle educationMultiple research studies demonstrating decreased mortality and morbidity from cardiac disease
CMS has expanded payment multiple times: added angioplasty with stents, CHFBundled payment model; Incentives for referrals to hospitals and physicians
American Association of Cardiovascular and Pulmonary Rehabilitation
https://www.aacvpr.org/Slide35
Traditional Rehab Patient
Home programsEnergy conservationMedication managementPreventing hospital readmissionsFall preventionSlide36Slide37
ReflectionsSlide38
References
American Occupational Therapy Association (2014). Occupational therapy practice framework: Domain and process (3rd ed.) American Journal of Occupational Therapy, 68 (Suppl. 1), S1-S48. doi.org/10.5014/ajot.2014.682006American Occupational Therapy Association (2013b). Occupational therapy in the promotion of health and well-being. American Journal of Occupational Therapy
, 67, S47-S59. doi:10.5014/ajot.2013.67S4 Baum, C.M. & Christiansen, C. H. (2005). Person-environment-occupation-performance: An occupation-based framework for practice. In C.H. Christiansen, C.M. Baum, and J. Bass-Haugen (eds.),
Occupational therapy: Performance, participation, and well-being
(3
rd
ed.).
Bourke-Taylor, H., Law, M., Howie, L., &
Pallant
, J. F. (2013).
Health Promoting Activities scale: Information booklet.
Hamilton, ON:
CanChild
. Retrieved from
https://canchild.ca/system/tenon/assets/attachments/000/000/087/original/HPAS_February2013.pdfSlide39
References
Centers for Disease Control and Prevention (2014). Chronic diseases and health promotion. Retrieved from http://www.cdc.gov/chronicdisease/overview/index.htmHildenbrand, W. & Lamb, A. (2013). Occupational therapy in prevention and wellness: Retaining relevance in a new health care world.
American Journal of Occupational Therapy, 67, 266-271. doi:10.5014/ajot.2013.673001Luebben, A. &
Royeen
, C. (2007). Toward
verstelhen
: An etymological and historical wave of the terms ‘habit’, ‘routine’, ‘occupation’, and ‘participation’. OTJR: Occupation, Participation, and Health, 27, 874-875.
Muskett
, R., Bourke-Taylor, H. & Hewitt, A. (2017).
Intrarater
reliability and other psychometrics of the Health Promoting Activities Scale (HPAS).
American Journal of Occupational Therapy
, 71. doi.org/10.5014/ajot.2017.021162
West, W. (1968). Professional responsibility in times of change.
American Journal of Occupational Therapy, 22,
9-15.